Organization
COASTAL PROSTHETICS & ORTHOTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN A SIVERD CPO (PRESIDENT, CPO)
(757) 892-5300
Entity
Organization
Contact information
Practice address
6330 N. CENTER DR., BLDG 13. STE 125, NORFOLK, VA 23502-4009
(757) 892-5300
(757) 892-5303
Mailing address
433 NETWORK STA, CHESAPEAKE, VA 23320-3851
(757) 892-5300
(757) 892-5303
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1029129
ACM
VA
01
—
39563
SENTARA
VA
01
—
434534
BCBS
VA
05
—
7703398
—
VA
05
—
9190414
—
VA
Enumeration date
04/26/2006
Last updated
06/26/2024
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